Ahh, Juicy Fruit

It is 45 years ago this month that a Stanford University Professor in Psychology, David Rosenhan put into play an experiment in an attempt to answer his own searching question of “If sanity and insanity exists, how shall we know them?” 

He must have known that his test was to be the equivalent of an earthquake amongst the psychiatric practices that were being carried out in the early 1970’s and will have been relied upon for decades before that. 

Rosenhan got together a group of individuals of certified sound mind and by complaining to a psychiatrist of the symptom of hearing voices on a persistent basis they got themselves referred to one or more Mental Hospitals. 

It was a carefully controlled set of symptoms with the voices comprised of only three words “empty”, “hollow” and “thud”. 

No other conditions or abnormalities were suggested by these pseudo patients and indeed any back stories were truthful and not embellished in any way. 

All of the group were immediately admitted into the care of professionals in the respective institutions. 

Furthermore, all but one were diagnosed with schizophrenia, the lone patient with manic depression. 

As soon as having been admitted the individuals stated, calmly and sanely, that the voices had disappeared and all asked when they would be discharged. 

In spite of the rapid reversion to completely normal behaviour the average detainment in the mental facilities was 19 days and this over a range of a week to an amazing 52 days. 

In this period of confinement the pseudo patients took part in the normal activities of a Ward but of course never took any of the cocktail of anti-psychotic drugs that had been prescribed. 

Very obviously the group took notes of their experiences and rather than alert the hospital staff to some sort of covert operation this was observed to be part of their mental state of mind as in a display of paranoia. 

What came out of the first person study was a shockingly inadequate level of contact between Therapists and patients- on average just 6.8 minutes per day which included admissions interviews, ward meetings, group and individual psychotherapy sessions, case conferences and discharge meetings. 

Other noted observations were that in any 8 hour shift the ward attendants only entered the secure areas an average of 11 and a half times and even then had minimal interaction with the patients. 

As for the psychiatrists themselves they rarely had any meaningful contact with any patient. 

In a sort of “One Flew Over the Cuckoo’s Nest” scenario it was the fellow patients, the real ones, who easily rumbled the identities of the insurgents and would often be heard to say things which, to a conscientious and informed member of the general or clinical staff, should have fully exposed the test subjects. 

When Rosenhan published his findings there were accusations that he had acted as “agent provocateur” and there was much uproar and controversy directed at the ethics of the study. 

Chief accusers and sceptics were of course those who had been exposed for their poor diagnoses and patient care. 

As a consequence of the storm of criticism Rosenhan indicated that there would be a follow up study specifically targeting one of the offending hospitals. 

It was implied that sometime in the proceeding three months there would be an attempt by one or more pseudo patients to get themselves admitted. 

Now alerted to another potential incursion the subject hospital ramped up their procedures. 

In a three month period some 193 patients were admitted for psychiatric treatment to that institution and 41 of these were suspected of being pseudo patients under the regime of heightened vigilance. Being deemed pretenders and sane these people were spared a diagnosis of permanent mental illness and a likely dependency on mind altering drugs. 

Rosenhan, in fact, did not actually activate any of his team to attempt admission anywhere and at any time. 

The experiment continues to have far reaching effects in psychiatric diagnosis and treatment some 45 years later. 

Rosenhan’s measured conclusions remain valid that the sane are not sane all of the time nor are those labelled insane actually insane all of the time. 

Sanity and insanity can be seen to have cultural variations and bizarre behaviour in people constitutes only a fraction of total behaviour. 

Essentially, psychiatric diagnoses, even those made in error, carry with them personal, legal and social stigmas that can be impossible to shake off and which often last a lifetime. 

There are obviously still lessons to be learned.